MRARTHROGRAPHY

AdamD.Olsan,MD
MedicalDirectorofAdvancedMRI
VicePresidentoftheRadiologicalSocietyof
Louisiana

MRArthrography
LearningObjectives
KnowwhatanMRArthrogramis.
WhyweperformMRArthrograms.
HowweperformMRArthrogams.
WhatMRArthrogramimageslooklike.

WhatisanMRArthrogram?

WhatisanMRArthrogram?
Arthrogram
Imagingofajointaftertheinjectionofcontrast
intothejoint.

WhatisanMRArthrogram?
Arthrogram
Imagingofajointaftertheinjectionofcontrast
intothejoint.

TraditionalArthrogram
Xrayimagingofajointaftertheinjectionof
iodinated contrastintothejoint.

WhatisanMRArthrogram?
Arthrogram
Imagingofajointaftertheinjectionofcontrast
intothejoint.

TraditionalArthrogram
Xrayimagingofajointafterinjectionofiodinated
contrastintothejoint.

MRArthrogram
MRimagingofajointafterinjectionofgadolinium
contrastintothejoint.

WhydoanMRArthrogram?

IndicationsforMRArthrography
Shoulder
Glenoidlabraltears(SLAPinjuries)
Rotatorcufftendontears

Hip
Acetabularlabraltears
Surgicalplanning

Wrist
Ligamenttears
Triangularfibrocartilagecomplextears

Elbow
Collateralligaments

HowdoweperformanMR
Arthrogram?

HowareMRArthrograms
performed?

MRArthrographyProcedure
Contrastsolutionvaries
5ccNormalSaline
5ccIodinatedcontrast
+/ 10ccAnestheticand
steroid
0.1ccGadolinium

Lidocaine1%without
Epi.forskinandsoft
tissues

MRArthrographyProcedure

MRArthrographyProcedure

MRArthrographyProcedure

MRArthrography
SomeAnatomyandCommon
Pathologies

Shoulder

NormalShoulderCoronal

NormalShoulderCoronal

NormalShoulderSagittal

NormalShoulderAxial

ShoulderCase#1

Normal

Abnormal

Normal

Abnormal

GlenoidLabralTear

SuperiorLabrumAnteriortoPosterior
(SLAP)

SLAPLesions
Tearofthesuperiorglenoidlabrumatthe
bicipitallabralcomplex.
Lesionscanvaryfromsimplefrayingand
fragmentationofthebicipitallabralcomplex
toabuckethandletear.
CanextendintoSurroundingstructures
AnteriorLabrum
MiddleGlenohumeralLigament
PosteriorLabrum

NextCase

Normal

Abnormal

GlenoidCartilageFracture
Normal

Abnormal

GlenoidCartilageFracture
Normal

Abnormal

GlenoidCartilageFracture
Normal

Abnormal

GlenoidCartilageFracture

GlenoidCartilageFracture

NextCase

Normal

Abnormal

Normal

Abnormal

RotatorCuffTendonTear

NextCase

Normal

Abnormal

Normal

Abnormal

Hip

NormalHipCoronal

NormalHipAxial

NormalHipSagittal

Acetabular Labrum
Fibrocartilaginous rim
which deepens
acetabulum.
Attaches to osseous
acetabular rim and
transverse acetabular
ligament.
Joint capsule
attaches to the
acetabular rim
adjacent to labrum

HipCase#1

Normal

Abnormal

NextCase

Normal

Abnormal

Normal

Abnormal

AcetabularLabralTears
Anterosuperior+posterosuperiorlabrumare
mostcommonlocations.
Baseoflabrum(detachments)oralonglong
axis.
Intraarticularcontrastfillstearanddistention
ofcapsulepromotesupliftingorseparationof
tornlabrumfromacetabularcartilage.

Causes of Acetabular Labral Tears

Osteoarthritis
HipDysplasia
FemoralAcetabularImpngement(FAI)

FemoroacetabularImpingement:
FAI
Causeofearlyosteoarthritisofthehip
especiallyinyoungandactivepeople.
Contactbetweenskeletalprominencesofthe
acetabulumandfemurlimitsphysiologichip
rangeofmotion.
Occurstypicallyduringflexionandinternal
rotation.
Patientsaretypicallyawareoflimitedhip
mobilitylongbeforesurgery.

CAMimpingement
FemoralcauseofFAI

Asphericalfemoralheadneckjunction
(usuallyanterolateralportionofthefemoral
neck)contactstheacetabulum.
Resultsinabrasionoftheacetabularcartilage
oritsavulsionfromthelabrumand
subchondralbone.
Chondralavulsioninturnleadstotearor
detachmentoftheadjacentlabrum.

FAI CAM

Pincerimpingement
AcetabularcauseofFAI
Focalorgeneralizedovercoverageofthe
femoralhead
Toolargewalloftheacetabulumor
retroversionoftheacatebulum.

FAI Pincer

FAI

FAI Osacetabuli

NextCase

Normal

Abnormal

NextCase

Normal

Abnormal

Normal

Abnormal

AvascularNecrosis

AvascularNecrosis
Necrosisofthebonesecondarytoischemia
Etiologies
Posttraumatic
Corticosteroiduse
Alcoholabuse
Lupus
Sicklecellanemia
Caisssondisease

Wrist

WristMRArthrography
TriangularFibrocartilageComplex(TFCC)
IntrinsicLigaments
ScapholunateandLunotriquetral

TFCC
Triangularfibrocartilage
VolarandDorsalradioulnarligaments
Meniscushomologue thickeningoftheulnar
jointcapsule;inconsistent
Ulnarcollateralligament
Tendonsheathoftheextensorcarpiulnaris
(ECU)

TFCC

AbnormalTFCC
Triangularfibrocartialge(TFC)ismost
commonlyabnormal
HighsignalextendingthroughtheTFC
indicatesatear
Tearscanbepartialorfullthickness
TFCcanhavemyxoiddegeneration

ScapholunateLigament
Origin/Insertion:Ulnarscaphoidtoradial
lunate;hyalinecartilageattachment
Action:Dorsalportionresistsvolardorsal
translation;Volarportionlimits
flexion/extension;proximalaccomodates
compressionandshearforcesacross
radiocarpaljoint

ScapholunateLigament
Ushapedligamentwithdorsal,proximaland
volarcomponents
Dorsalcomponentthicker(5mm)thanvolar(1
2mm);functionallymoreimportantthatproximal
portion
Proximalcomponentismescuslikeavascular
fibrocartilage;triangularshape

Attritionaltearswithage

LunotriquetralLigament
Origin/insertion:Ulnarlunatetoradial
triquetrum;hyalinecartilageattachment
Action:Volarportionlimitstranslationof
lunateandtriquetrum;dorsalportion
stabilizesjoint

LunotriquetralLigament
Ushapedligamentwithdorsal,proximaland
volarcomponents
Volarcomponentthicker(23mm)thandorsal
(1mm);functionallymoreimportantthan
proximalportion
Proximalcomponentismesiscuslikeavascular
fibrocartilage;triangularshape

Attritionaltearswithage

WristCase#1

WristCase#2

Elbow

NormalElbowAxial

NormalElbowAxial

NormalElbowAxial

NormalElbowSagittal

NormalUlnarCollateralLigament
(UCL)

NormalRadialCollateralLigament
(RCL)

Normal

Abnormal

TornUlnarCollateralLigament
(UCL)
Normal

Abnormal

Normal

Abnormal

TornRadialCollateralLigament
Normal

Abnormal